An audit of conjunctival melanoma treatment in Liverpool

To evaluate treatment of conjunctival melanomas at the Ocular Oncology Service in Liverpool.

We included 40 patients initially treated at our centre for invasive conjunctival melanoma and 36 patients referred for salvage therapy after surgery elsewhere. Patients underwent local excision or radiotherapy. Adjunctive cryotherapy for invasive and intra-epithelial neoplasia was abandoned in favour of ruthenium brachytherapy and mitomycin C chemotherapy, respectively. Tumours were staged according to circumferential spread, basal diameter, and histological thickness.

The 40 previously-untreated tumours were confined to bulbar conjunctiva in 31 patients and involved extrabulbar conjunctiva in 9, affecting caruncle in 6 of these. All eyes were conserved, most retaining initial visual acuity. Invasive conjunctival recurrence, which occurred in six patients, was more likely with medial tumours (Log-rank, P=0.004) and if treatment did not include radiotherapy (Log-rank, P=0.03). Four patients died of metastases, all with caruncular involvement. Of the 36 patients referred for salvage therapy after previous surgery, 11 had no visible tumour, 9 had only intra-epithelial neoplasia, and 16 had invasive melanoma, which was recurrent in seven. After salvage therapy, five patients died, all of whom were referred with recurrent invasive tumour and only one of whom had caruncular involvement.

Excision of invasive melanoma with adjunctive brachytherapy and topical chemotherapy achieved high rates of local tumour control with little ocular morbidity. Without caruncular involvement, disease-specific mortality was rare unless the patient was referred after a surgical procedure. Our results suggest that inadequate surgical intervention increases risks of local recurrence and metastatic death.